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Introduction Healthcare providers (physicians) are highly mobile and examine patients while moving between various facilities. Decisions about patient care often requires information from variety of sources both internal and external to the organization. Motivation

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Introduction Current System Typically in the United States patients are under managed healthcare plans from healthcare insurance organizations. As part of their cost curtailment procedures, these insurance agencies require healthcare providers to obtain prior authorization before prescribing a course of treatment, including –referrals to specialists, –admission to hospitals, –diagnostic procedures, –surgeries –for some medications. Motivation

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Introduction Major hindrances to this process are Limited face-to-face encounter time (<5-10 minutes ) in which to decide best course of treatment Widely varying health benefits and pre-certification regulations among insurance agencies. Motivation

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Introduction Thus often physicians are ill-equipped to provide a course of treatment which addresses the patient's needs and is compliant with the agencys procedures. Consequently they may feel as seen not to be in control of the care giving procedure and experience a loss of credibility. Motivation

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Current Practices :- Submit justifications for recommended treatments and await approval. If disallowed then form alternative care plans. Regulations for each patients insurance agency is ascertained manually through use of cheat-sheets. Introduction Motivation

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Requests are made on paper-based forms which are then faxed across to the agency. These have to be examined by administrators and replies have to be faxed which can take up to 48 hours or more. Communication is primarily using fax and/or telephone. Introduction Motivation

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Drawbacks of Current Practices:- Incomplete, invalid information due to human errors result in additional delays as they have to be rectified after being detected. Confidential patient medical records are faxed openly which may result in compromising their security due to loss or theft. Introduction Motivation The physicians inability to provide a timely course of treatment due to the above factors results in a deterioration in the overall quality of care provided.

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Our Solution Use of available technologies to address the needs of mobile healthcare providers involved in such transactions. This solution may be considered as a framework for systems with similar needs in other domains too. The rest of this presentation is as follows: Introduction Motivation

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Previous Work To tackle the issue of enabling such transactions, we created a Web-Based Implementation as part of the Secure Collaborative Telemedicine Project at CERC, WVU (May 2000) Handled key issues in such systems, namely: –Workflow –Interoperability –Communication –Security –Process Efficiency

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Use of ubiquitous Internet and WWW (HTTPS protocol) enabling organizations to communicate, thereby easing development and deployment. ( Used Microsoft IIS 4.0) Client application being a browser, greatly simplified installation and use. Workflow involved in each organization could be handled through server-side scripting. (Active Server Pages) Requests made using forms. (HTML, DHTMLand scripting) Previous Work Features

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Communication between organizations enabled both, –Synchronously : through HTTPS –Asynchronously : through notification, thus minimizing delays. Security enforced using HTTPS and SSL (for encryption). Authentication of clients and servers, possible through X509 digital certificates. Process Efficiency improved by –Minimizing errors by use of Smartcards and automatic form filling using Active Components –Client side validation using JavaScript. Previous Work Features

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User mobility supported as user is not tied to any one domain (Windows NT 4.0) by use of Smartcards. –Cards carrying physician information could be used at any workstation with card reader. – Browser extracts certificate from card and uses it in the authentication process. Thus user does not have to depend on certificates being present on the machine. Previous Work Features

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Previous implementation proves insufficient because Users needed a desktop/laptop (wired terminal) to use the system. Centralized setting in many clinics. Each organization had a separate form with its own format which had to be filled (automatically). In spite of smartcard automation significant amount of information had to be entered Previous Work Disadvantages with respect to Mobile users

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Mobile Solution *Use of a wireless device to conduct such a process over a wireless network. *Due to input-output constraints of wireless devices minimal or just-enough input of information. *Use of secure protocols to ensure patient information security over both wireless and wired networks. Key Features

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Mobile Solution *Use of common data exchange format to enable heterogeneous systems to interoperate. *Process efficiency improved through local workflow in the Healthcare Provider system. Key Features

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ImplementationMobile User Application Features of J2ME Transport protocol neutral Support for HTTPS Rich customizable GUI As opposed to a WAP like model, eliminates the extra node. Can make use of device dependent features if any. Build powerful applications depending on the device (parse XML on the device ) Can support an application suite

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ImplementationWf-XML Features Features of Common data exchange format like Wf-XML Advantages of an XML based exchange format Can support any sort of domain specific XML within it (Contextdata and Resultdata tags) Not bound to any specific transport mechanism Can be packaged /parsed easily using JAXP or customized tools. For this application one common DTD encompassing all elements can be created. Specific elements can be used by interested parties. Wf-XML need not be extended.

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Summary Reference Implementation provided for applications involving the following: –Information access and decision support for mobile users using wireless devices. –Remote activation of workflow and obtaining results in spite of wireless device constraints. –Interoperability through the common data exchange mechanism –Information confidentiality maintained –Demonstrates an improvement in overall process efficiency by various mechanisms such as client side validation, local system workflow. This could be extended to other domains with similar needs.

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Summary What is needed is a consensus among various participating organizations over the actual context data for a domain such as healthcare and creation of appropriate DTD(s). These will dictate the requirements of the parsers and validation components needed to complete such applications.